1 / 7

Overview: Pre-renal Disease and Acute Tubular Necrosis

Overview: Pre-renal Disease and Acute Tubular Necrosis. By: David I. Driver, MS III. Introduction.

ellery
Download Presentation

Overview: Pre-renal Disease and Acute Tubular Necrosis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Overview:Pre-renal Disease and Acute Tubular Necrosis By: David I. Driver, MS III

  2. Introduction • The incidence of acute renal failure, independent of underlying cause, varies widely based upon the definition utilized and the patient population. Reported rates have varied from 100 to 600 per million per year • The incidence of acute renal failure is very high in hospitalized patients. An incidence of six percent has been reported among patients admitted to intensive care units, whereas among all hospitalized patients, rates of two to five percent have been reported

  3. Etiology • The two major causes of acute renal failure developing in the hospital are acute tubular necrosis and prerenal disease • Other, less common causes of acute renal failure can be diagnosed from their characteristic features in the history, urinalysis, and, if indicated, ultrasonography. These include: • Urinary tract obstruction, usually evident as hydronephrosis on ultrasonography. • Acute interstitial nephritis, typically with a history of an offending drug plus a urinalysis showing red and white cells and, in many cases, eosinophils and white cell casts. • Acute glomerulonephritis, generally with urinalysis showing red cells, red cell casts, and proteinuria.

  4. Diagnosis • Prerenal disease and postischemic or nephrotoxic ATN can usually be distinguished by complete examination of the urine and by serial measurements of the BUN and plasma creatinine concentration. • The major distinguishing findings between prerenal disease and ATN include: • BUN/plasma creatinine ration • Rate of rise of plasma creatinine concentration • Urinalysis • Urine sodium concentation • Fractional excreation of sodium • Urine osmolality • Urine volume • Urine to plasma creatinine concentration • Novel markers • Neutrophil gelatinase-associated lipocalin

  5. References • 1. Lameire, N, Van Biesen, W, Vanholder, R. Acute renal failure. Lancet 2005; 365:417. • 2. Uchino, S, Kellum, JA, Bellomo, R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005; 294:813. • 3. • Liangos, O, Wald, R, O'Bell, J, et al. Epidemiology and outcomes of acute renal failure in hospitalized patients: A national survey. Clin J Am Soc Nephrol 2006; 1:43. • 4. Hou, SH, Bushinsky, DA, Wish, JB, et al. Hospital-acquired renal insufficiency: A prospective study. Am J Med 1983; 74:243. • 5. Liano, F, Pascual, J, and the Madrid Acute Renal Failure Study Group. Epidemiology of acute renal failure: A prospective, multicenter, community-based study. Kidney Int 1996; 50:811. • 6. Nolan, CR, Anderson, RJ. Hospital-acquired acute renal failure. J Am Soc Nephrol 1998; 9:710. • 7. Mehta, RL, Pascual, MT, Soroko, S, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int 2004; 66:1613. • 8. Miller, TR, Anderson, RJ, Linas, SL, et al. Urinary diagnostic indices in acute renal failure: A prospective study. Ann Intern Med 1978; 89:47. • 9. Espinel, CH, Gregory, AW. Differential diagnosis of acute renal failure. Clin Nephrol 1980; 13:73. • 10. Esson, ML, Schrier, RW. Diagnosis and treatment of acute tubular necrosis. Ann Intern Med 2002; 137:744. • 11. Myers, BD, Miller, C, Mehigan, JT, et al. Nature of the renal injury following total renal ischemia in man. J Clin Invest 1984; 73:329. • 12. Chalasani, N, Clark, WS, Wilcox, CM. Blood urea nitrogen to creatinine concentration in gastrointestinal bleeding: A reappraisal. Am J Gastroenterol 1997; 92:1796. • 13. Dixon, BS, Anderson, RJ. Nonoliguric acute renal failure. Am J Kidney Dis 1985; 6:71. • 14. • Eknoyan, G. Renal disorders in hepatic failure (letter). Br Med J 1974; 2:670. • 15. Herget-Rosenthal, S. One step forward in the early detection of acute renal failure. Lancet 2005; 365:1205. • 16. Kjeldsen, L, Johnsen, AH, Sengelov, H, Borregaard, N. Isolation and primary structure of NGAL, a novel protein associated with human neutrophil gelatinase. J Biol Chem 1993; 268:10425. • 17. Mishra, J, Ma, Q, Prada, A, et al. Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol 2003; 14:2534. • 18. Mishra, J, Mori, K, Ma, Q, et al. Amelioration of ischemic acute renal injury by neutrophil gelatinase-associated lipocalin. J Am Soc Nephrol 2004; 15:3073. • 19. Mori, K, Lee, HT, Rapoport, D, et al. Endocytic delivery of lipocalin-siderophore-iron complex rescues the kidney from ischemia-reperfusion injury. J Clin Invest 2005; 115:610. • 20. Mishra, J, Dent, C, Tarabishi, R, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005; 365:1231.

More Related